Provider Demographics
NPI:1184604316
Name:SUCHYTA, F ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:F
Middle Name:ROBERT
Last Name:SUCHYTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:27015 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1901
Mailing Address - Country:US
Mailing Address - Phone:313-562-1030
Mailing Address - Fax:313-562-1581
Practice Address - Street 1:27015 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1901
Practice Address - Country:US
Practice Address - Phone:313-562-1030
Practice Address - Fax:313-562-1581
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E25874Medicare UPIN